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NURS 6630 FINAL EXAM EXAM ELABORATIONS QUESTIONS AND ANSWERS NEWLY UPDATED NURS 6630 FINAL EXAM: WALDEN UNIVERSITY QUESTION 1 What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? A. Stimulants B. Antidepressants C. Mntipsyehoties D. SSRIs QUESTION 2 The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control] and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism? A. First-gencration, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-gencration, conventional antipsychotics D. Second-generation, atypical antipsychotics QUESTION 3 The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in paticnts with the student. Why docs the PMHNP prescribe a standard dose of atypical antipsychotics? A. The doses are based on achicving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. ‘The doses are based on achieving 60% D2 receptor occupancy. D. None of the above. QUESTION 4 Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression? D. Adderall QUESTION 8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? A. 8-year-ald patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient QUESTION 9 A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMUIINP include when discussing the side effects with the patient? A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C, ‘The medication can affeet your blood pressure. D. This drug does not cause any dependency. QUESTION 10 The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMUNP include in the teaching? A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening. QUESTION 11 A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMIINP think that the dosing is being done incorrectly? A. “Ttake my pill at breakfast.” B. “Lam unable to fall asleep at night.” C. “T feel okay all day long.” D. “Tam not taking my pill at lunch.” QUESTION 12 A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile? A. The patient should take the medication at lunch. B. The patient will have one or two doses aday. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night. QUESTION 13 The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose: A. The child will be preseribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10-40 mg, daily. QUESTION 14 A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHMP tell the patient regarding bupropion? A. Weight gain is not unusual. B. Sedation may be common. C. It cam cause cardiac arrhythmias. D. It may amplify fatigue. QUESTION 15 Which patient will receive a lower dose of guanfacine? A. Patient who has congestive heart failure BePatient who-has cerebrovasertbar-disease rrr this patient understands? A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and QUESTION 20 A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? A, Order herpes simplex virus (SV) antibody testing B. Order a blood urea nitrogen (BUN) andcreatinme STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg QUESTION 21 The PMIINP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take? A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection. QUESTION 22 An elderly woman with a history of Alzheimer’s disease, coronary artery discase, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While asscssing this patient, the PMHNP is made aware that the paticntcontinucs to expericnee mild to moderate pain. What is the PMHNP most likely to do? A, Order an X-ray because it is possible that she dislocated her hip. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy. QUESTION 23 The PMIINP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMUINP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? A. Orders liver function tests. B. Educate the paticnt on avoiding grapefruits when taking this medication. C. Encourage this paticnt to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test. QUESTION 24 The PMHNP is evaluating a 30-year-old female paticnt who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The paticnt states that she has tried dict and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C D. Prescribe risperidone (Risperdal), 2 mg TID QUESTION 25 A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain tothe patient? A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRT can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” QUESTION 30 The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select? A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxctine (Strattera) QUESTION 31 A patient with irritable bowel syndrome reports chronic stomach pain. The PMIINP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? A, Pregabalin (Lyrica) B. Gabapentin (Neurontin) C, Duloxetine (Cymbalta) D. Band C QUESTION 32 The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How docs the PMHNP go about treating this paticnt? A. Prescribing the paticnt an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and D.None of the above QUESTION 33 The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently uscful in treatingthis particular patient’s pain. What is the best response by the PMHNP? A. “SSRIs only increase norepinephrine levels.” 8. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.” QUESTION 34 A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe’? A. Antipsychotics B. Lithium C. SSRI D. Naltrexone QUESTION 35 Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHINFP tell the parents regarding his treatment options? A. “Naltrexone may he an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” QUESTION 36 Which statement best describes a pharmacological approach to treating patients for impulsive aggression? A. Anticonvulsant mood stabilizers can eradicate limbic writability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to deercase frontal inhibition. QUESTION 40 The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state? A. Histamine 2 reecptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine QUESTION 41 The PMHNP is caring for a paticnt who expericnecs too much overstimulation and anxicty during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t wantto feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options? A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D. None of the above QUESTION 42 The PMIINP is performing a quality assurance peer review of the chart of another PMIINP. Upon review, the PMHINP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation? A. Older adult patients are contraindicated to take hypnotics. B. Ilypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly. QUESTION 43 The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia? A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non- henzodiazepine hypnotics QUESTION 44 The PMHNP is caring for a paticnt with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the paticnt a drug with an ultra-short half-life (1-3 hours). Which drug will the PMHNP prescribe’? A. Flurazepam (Dalmanc) B. Estazolam (ProSom) C. Triazolam (Haleion) D. Zolpidem CR (Ambien) QUESTION 45 The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1-2 hours. What is the most appropriate prescription for the PMIINP to make? A. ‘Triazolam (Haleion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane) QUESTION 49 Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start? Methylphenidate Amphctamine salts Atomoxctine All of the above could potentially treat theirson’s symptoms. QUESTION 50 An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option? A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C, Atomoxetine (Strattera) D. Fluoxetine (Prozac) QUESTION 51 An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe? A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D.Desipramine (Norpramin) QUESTION 52 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMIINP determines that which of the following medications may be beneficial in augmenting stimulant medication? A, Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C, Guanfacine ER (Intuniv) D. Atomoxetine (Strattera) QUESTION 53 A PMIINP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response? A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above. QUESTION 54 A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following? A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents. QUESTION 55 A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider? A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reportedimpact on ADHD symptoms. QUESTION 59 The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia? A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil QUESTION 60 A group of nursing students seeks further clarification from the PMIINP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response? A, Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.” QUESTION 61 The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this paticnt, and what medication would the PMHNP want to avoid given these other factors? A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxicty and avoid methylphenidate D. Both “A” & “B” QUESTION 62 A 72-year-old male patient is in the carly stages of Alzheimer’s discase. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice? A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D, All of the above QUESTION 63 A 63-ycar-old paticnt presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Sclect the answer that is matched with an appropriate treatment. A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. 8. Impairment in the ability to learn and retain new information is most problematic, and C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil. QUESTION 64 A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option? A. Immunotherapy B. Donepezil (Aricept) C. Halopcridol (Haldol) 
